OptumHealth Care Solutions MTP Paper Referral Form 2007-2025 free printable template

Use this form to notify OptumHealth Care Solutions of your transplant referral. Please fax to your Managed Transplant Program Case Manager at Fax: 18552502169 or email to trans optumhealth.com SECTION

How to fill out OptumHealth Care Solutions MTP Paper Referral

How to fill out OptumHealth Care Solutions MTP Paper Referral Form

1. Begin by writing the patient's personal information at the top of the form, including full name, date of birth, and contact details.
2. Fill in the referring provider's information, including name, contact number, and address.
3. Indicate the type of service or procedure being requested.
4. Provide the patient's insurance details, including policy number and group number.
5. Check the appropriate boxes for the patient's diagnosis and relevant medical history.
6. Specify the urgency of the referral by selecting the relevant option (routine, urgent, etc.).
7. Include any necessary medical records or documentation to support the referral.
8. Sign and date the form to validate it.
9. Submit the completed form to the appropriate OptumHealth office or fax number.

Who needs OptumHealth Care Solutions MTP Paper Referral Form?

1. Patients requiring specialized medical services or procedures may need the OptumHealth Care Solutions MTP Paper Referral Form.
2. Healthcare providers who are referring patients for additional care or services within the OptumHealth network will also need this form.

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What is OptumHealth Care Solutions MTP Paper Referral Form?

The OptumHealth Care Solutions MTP Paper Referral Form is a document used to initiate and authorize referrals for medical treatment programs under OptumHealth.

Who is required to file OptumHealth Care Solutions MTP Paper Referral Form?

Healthcare providers and professionals who are referring patients for medical treatment programs are required to file the OptumHealth Care Solutions MTP Paper Referral Form.

How to fill out OptumHealth Care Solutions MTP Paper Referral Form?

To fill out the form, provide the required patient information, details of the referring provider, the purpose of the referral, and the services requested, ensuring all sections are completed accurately.

What is the purpose of OptumHealth Care Solutions MTP Paper Referral Form?

The purpose of the form is to facilitate the referral process for medical treatment to ensure that patients receive the necessary care in a timely manner.

What information must be reported on OptumHealth Care Solutions MTP Paper Referral Form?

The form must include patient demographic information, insurance details, the referring provider's information, the specific treatment or services requested, and any relevant medical history or notes.